Monthly Archives: September 2015

Coenzyme Q10 (CoQ10) has become a popular supplement which is said to help with a number of health issues including cataract and macular degeneration in the eye, but the Mayo Clinic gives it a “C” grade for its benefits in the eye (meaning the evidence is unclear to support its use). CoQ10 is also called Q10, Vitamin Q10, ubiquinone, and ubidecarenone. It acts as an antioxidant in the body and has a role in producing ATP which is a molecule which provides energy to cells. CoQ10 deficiency has not been reported in the general population and it is estimated that a varied diet will provide up to 25% of the measured plasma CoQ10 and that the body naturally makes the remainder. Primary CoQ10 deficiency is a rare inherited disorder that causes neurologic and muscular dysfunction.

For healthy individuals there is not strong evidence to show that CoQ10 supplements improve athletic performance or prolong life. There may be some specific circumstance where CoQ10 supplementation may be helpful. There is some scientific evidence to show that it may be helpful in chronic heart failure and in the treatment of high blood pressure but more studies are needed. CoQ10 has also been thought to be helpful in specific cancer patients who are undergoing chemotherapy. There are not enough studies to show that CoQ10 is helpful for eye conditions such as macular degeneration. According to some sources CoQ10 should not be used for diabetes, hepatitis C, or Huntington’s disease.

There have been some studies that use CoQ10 eye drops for some specific conditions affecting the retina, cornea, and optic nerve. While early studies are promising for specific diseases, more studies are needed. More commonly studies have used a tablet or capsule, injection, or intravenous (IV) CoQ10. There are some side effects including insomnia, elevated liver enzymes, rash, heartburn, and fatigue that have been reported when using CoQ10. As with all supplements be sure to check with your doctor or pharmacist before starting to take CoQ10 as it may interact with other medications (in particular blood thinners).

Foods that contain higher amounts of CoQ10 include beef, herring, chicken, soybean, canola oil, rainbow trout, roasted peanuts, sesame seeds, pistachio nuts, broccoli, cauliflower, orange, strawberries, and eggs. A varied diet is helpful in providing a wide variety of nutrients and since CoQ10 appears to act in concert with other vitamins such as vitamin E, having a dietary source of this vitamin may help provide CoQ10 along with other nutrients and co-factors that will aid in absorption and in action. CoQ10 naturally declines with age so maintaining a healthy diet is increasingly important. Given the scientific evidence to date it seems unlikely that CoQ10 supplementation is helpful for vision in healthy people.

If you have questions about laser vision correction or wish to book a complimentary evaluation with Dr. Anderson Penno, contact Western Laser Eye Associates.

If you or your children wear glasses for nearsightedness (myopia) you have probably seen advertisements for vitamins and supplements that claim to prevent or reduce nearsightedness. Approximately 1.6 billion people were nearsighted in 2000, and up to 2.5 billion worldwide are expected to be nearsighted by 2020. The myopia boom in East Asia has resulted in an increase in myopia from 10-20% in China in the mid-twentieth century to up to 90% of teens and young adults with nearsightedness today. According to a recent article in the journal Nature up to 96% of 19 year olds in Seoul are nearsighted. While there is a genetic or hereditary cause for nearsightedness, this increase in myopia worldwide indicates that other factors may be important.

It has been a longstanding theory that prolonged near work including reading and screen time may lead to an increase in nearsightedness. A newer finding is that light levels and time spent outdoors in natural light may be protective in preventing myopia progression – and in some countries public health posters tell children to “Keep Myopia Away, Go Outside And Play!” There does seem to be a positive effect of natural light (and not just that playing outside does not involve reading or near work) since some animal studies confirm this finding.

Can vitamins prevent increasing nearsightedness? There is little evidence to prove most of the various vitamins and supplements that are marketed to reduce myopia, except more recently for Vitamin D. There may be a connection between the findings that more time in natural light seems to reduce increases in nearsightedness and the Vitamin D findings. When UVB from sunlight shines on bare skin the body produces Vitamin D. This vitamin can also be found in fortified milk, cereal, and other foods. In spite of this many people may be deficient. A blood test can determine your Vitamin D levels to find out if you are deficient. Supplements can boost your Vitamin D levels, but too much can lead to dangerously high calcium levels – so as with all supplements and vitamins more isn’t always better. It is advisable to work with a nutritionist or physician to determine the dose that is right for you.

While there is no strong studies to support taking other supplements to prevent increasing nearsightedness, it is a good idea to have a diet which includes colored fruits and veggies, fish, and nuts.

If you have questions about laser vision correction or wish to book a complimentary evaluation with Dr. Anderson Penno, contact Western Laser Eye Associates.

According to some reports over 28 million laser vision correction surgeries have been performed worldwide since the excimer laser was developed in the 1980s. Both PRK surface laser and LASIK surgeries use the excimer laser to reshape the corneal surface. The main difference between the two types of laser vision correction methods is the creation of a corneal flap with LASIK and treatment on the surface of the cornea after removing the thin layer of epithelial cells with PRK.

Advances in both the excimer laser and in flap creation technology have resulted in a variety of names for laser vision correction surgeries. Flap surgeries include LASIK and IntraLase and no flap treatments include PRK, LASEK, and Epi-LASIK. With LASIK a small oscillating blade in a device called a microkeratome is used to cut the LASIK flap. With IntraLase the femtosecond laser is used to create a corneal flap. Originally called “flap and zap”, with LASIK and Intralase the flap is lifted and the excimer laser reshaping is done on the underlying corneal tissue. With no flap treatments the excimer laser energy is applied directly to the surface of the cornea.

PRK surface laser vision correction gained in popularity from it’s introduction in the 1980s over the next decade. LASIK was introduced in the 1990’s and became the most popular laser vision correction by the early 2000’s due to faster recovery. Within the past several years there has been a shift back towards surface treatments due to the improvements in post operative management and in excimer laser technology. It has also been determined that for some people PRK surface treatments may be a better choice. The reasons that PRK may be recommended include:

1. Risk of flap shift or trauma with job or sports activities.

2. Thin corneas that may be a risk for ectasia (unstable cornea with progressive thinning) with LASIK flap.

3. Very steep or very flat corneal curvatures that may increase LASIK flap complication risk.

4. Previous injury or eye or eyelid surgeries that may raise the risk of LASIK flap complications.

Both LASIK and PRK have be demonstrated to produce equally good results over 6 months or more. In the short term of days to weeks LASIK patients will recover vision more quickly. So taking a short term perspective it makes sense that people may choose a LASIK flap laser vision correction method.

Taking a long term approach there are advantages to forgeting the LASIK flap and choosing a no flap PRK surface treatment. Advantages of a no flap PRK approach include:

To make the choice that is right for you, first find out if you qualify for laser vision correction and then learn the pros and cons of the treatments available to you. If you have questions about laser vision correction or wish to book a complimentary evaluation with Dr. Anderson Penno, contact Western Laser Eye Associates.

Vitamin A. This first to be discovered vitamin is found in a wide variety of fruits and veggies as well as eggs. Vitamin A deficiency is rare in North America but worldwide the World Health Organization estimates that 250 000 to 500 000 vitamin A-deficient children become blind every year, half of them dying within 12 months of losing their sight. The World Health Organization is working to supply Vitamin A supplements and foods rich in Vitamin A to needy countries around the world including in Asia, Africa and South America.

Vitamin A can also be harmful in high doses. This can be a problem if large doses of supplements are taken over a long period of time and can damage the eye and other organs. It is uncommon to overdose on Vitamin A with food but acute overdose can occur from eating polar bear liver or chronic overdose can happen over a long period of time from taking supplements like cod liver oil which will harm the liver, eye, and skin. As with all supplements it is important to be aware of recommended dosages and keep in mind that more is not better as the body is a finely balanced system. It is not possible to overdose on Vitamin A by eating fruits and vegetables since plant-based vitamin A precursors such as beta-carotene (in addition to other mixed carotenoids) are regulated by the body which prevents overdose.

Vitamin A can be measured but it is too costly to be practical in third world countries. In North America Vitamin A deficiency is uncommn so if Vitamin A deficiency is suspected then a secondary cause such as celiac disease may be investigated. Most overdoses of Vitamin A are due to over supplementation and the treatment is to stop the supplementation.

Any time vision changes are noted it is a good idea to contact your optometrist or ophthalmologist to investigate possible causes. While reduced night vision can be a symptom of Vitamin A deficiency, in North America it is more likely to be caused by other more common disorders such as cataracts. If you have questions about laser vision correction or wish to book a complimentary evaluation with Dr. Anderson Penno, contact Western Laser Eye Associates.

I am a fan of food. The most powerful health advice is common sense – simple and straightforward. Don’t smoke, exercise, get your blood pressure and blood sugar checked, and have regular screening exams both for eyes and general health. Michael Pollan’s seven words – Eat Food, Mostly Plants, Not Too Much – are a beautiful example of this simple approach. My other favorite is one I heard at a conference years ago – Eat a little bit of everything and not too much of any one thing. Another favorite is – Eat around the outside of the grocery store. The outside perimeter almost always contains the fresh vegetable, dairy, and fish/meats and the center has more of the processed foods. With whole foods (not processed) the ingredients are reliable and unknown additives will not be an issue. Supplements are not regulated like prescription medications so some of them may not contain the listed ingredient and some have harmful additives that are not listed on the labels. It is nearly impossible to harm yourself with food when eaten in usual amounts – “not too much” . One exception to this is eating polar bear liver which can harm the eye due to overloading vitamin A.

By eating a wide variety of foods and not too much, most adults will be able to consume the nutrients needed for good eye health. Foods also contain fiber and other micronutrients that are essential for good health. It is also less likely that food will interfere with prescription medications, although there are exceptions to this. Grapefruit is know to interact with a number of prescription medications and blood thinners may be more likely to be affected by certain foods like broccoli. With mindful eating the eye healthy nutrients will be part of your diet including the colorful fruits and veggies, and in fish and nuts.

With that said, it your diet is poor or if you have early high risk macular degeneration then supplements may be helpful. However, if you smoke then it is probably a waste of money to buy supplements unless you first quit smoking. Other groups of people that may benefit from supplements include pregnant women and people with problems absorbing vitamins. There is no definite evidence to show that vitamins will prevent eye disease, but there is some scientific evidence to support taking AREDS 2 formula vitamins for people with early but high risk macular degeneration. There is also some suggestion that certain fatty acids such as those found in flaxseed and fish oil may be helpful for treatment of dry eye. The effects of vitamins and supplements is very hard to study in a scientifically rigorous way due to the need for very large number of people who will need to be included in the studies and the length of time, possibly years, needed to see statistically significant effects. So the risks and benefits are sometimes not clear for decades. There are also a lot of confounding factors like smoking, diabetes, or other chronic diseases that may impact health whether or not supplements are taken. In fact in some cases long term studies show that supplements may be causing harm as in the case of vitamin E. There has been some suggestion in the scientific literature that vitamin E supplementation might be associated with an increase in total mortality (death), heart failure, and stroke.

The best approach is mindful eating for everyone and mindful supplementation for select people. At worst vitamins and supplements may harm you, and they may be a waste of money. Regardless if you need glasses or contacts, certain people are likely to benefit from select supplements, so do your homework and talk to your doctor and nutritionist to make sure you are making good choices with your health and nutrition. Exercise and don’t smoke. If you have questions about laser vision correction or wish to book a complimentary evaluation with Dr. Anderson Penno, contact Western Laser Eye Associates.